Subject(s)
Diabetic Retinopathy , Practice Patterns, Physicians'/standards , Academies and Institutes/standards , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/epidemiology , Diabetic Retinopathy/therapy , Diagnostic Techniques, Ophthalmological , Drug Therapy , Female , Humans , Male , Ophthalmologic Surgical Procedures , Ophthalmology/organization & administration , Prevalence , Risk Factors , United StatesSubject(s)
Practice Patterns, Physicians'/standards , Retinal Degeneration , Retinal Detachment , Retinal Perforations , Vitreous Detachment , Academies and Institutes/standards , Delivery of Health Care/standards , Diagnostic Techniques, Ophthalmological , Female , Humans , Male , Ophthalmologic Surgical Procedures , Ophthalmology/organization & administration , Retinal Degeneration/diagnosis , Retinal Degeneration/therapy , Retinal Detachment/diagnosis , Retinal Detachment/therapy , Retinal Perforations/diagnosis , Retinal Perforations/therapy , Risk Factors , United States , Vitreous Detachment/diagnosis , Vitreous Detachment/therapySubject(s)
Macular Degeneration/diagnosis , Macular Degeneration/therapy , Practice Patterns, Physicians'/standards , Academies and Institutes/standards , Aged , Angiogenesis Inhibitors/therapeutic use , Coloring Agents/administration & dosage , Female , Fluorescein Angiography , Humans , Indocyanine Green/administration & dosage , Intravitreal Injections , Laser Coagulation , Male , Ophthalmology/organization & administration , Quality of Health Care/standards , Tomography, Optical Coherence , United States , Vascular Endothelial Growth Factor A/antagonists & inhibitorsSubject(s)
Practice Patterns, Physicians'/standards , Retinal Perforations , Academies and Institutes , Age Factors , Diagnosis, Differential , Early Diagnosis , Female , Fibrinolysin/therapeutic use , Humans , Male , Middle Aged , Ophthalmology/organization & administration , Peptide Fragments/therapeutic use , Retinal Perforations/diagnosis , Retinal Perforations/epidemiology , Retinal Perforations/surgery , Sex Factors , Societies, Medical/standards , United States , Vitreoretinal SurgerySubject(s)
Epiretinal Membrane , Eye Diseases , Macula Lutea/pathology , Practice Patterns, Physicians'/standards , Vitreous Body/pathology , Academies and Institutes , Endotamponade , Epiretinal Membrane/diagnosis , Epiretinal Membrane/etiology , Epiretinal Membrane/therapy , Eye Diseases/diagnosis , Eye Diseases/etiology , Eye Diseases/therapy , Fibrinolysin/therapeutic use , Humans , Incidence , Ophthalmology/organization & administration , Peptide Fragments/therapeutic use , Risk Factors , Societies, Medical/standards , Syndrome , Tissue Adhesions , Tomography, Optical Coherence , United States , VitrectomySubject(s)
Ophthalmic Artery/pathology , Practice Patterns, Physicians'/standards , Retinal Artery Occlusion , Academies and Institutes , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/therapy , Humans , Incidence , Laser Coagulation , Ophthalmic Artery/drug effects , Ophthalmic Artery/surgery , Ophthalmology/organization & administration , Prevalence , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/etiology , Retinal Artery Occlusion/therapy , Risk Factors , Societies, Medical/standards , Thrombolytic Therapy , United States , Visual Acuity/physiologySubject(s)
Practice Patterns, Physicians'/standards , Retinal Vein Occlusion , Academies and Institutes , Angiogenesis Inhibitors/therapeutic use , Glucocorticoids/therapeutic use , Humans , Laser Coagulation , Ophthalmology/organization & administration , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/etiology , Retinal Vein Occlusion/therapy , Societies, Medical/standards , United States , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vision Disorders/prevention & controlABSTRACT
BACKGROUND: Introduction of highly active antiretroviral therapy has altered the course of disease for persons infected with human immunodeficiency virus by elevating CD4+ T-lymphocyte levels. Changes in the spectrum of systemic diseases encountered in human immunodeficiency virus-positive individuals are reported in the general medical literature. DESIGN: Retrospective case series. PARTICIPANTS: Sixty-one individuals infected with human immunodeficiency virus, who presented with uveitis when the peripheral CD4+ T-lymphocyte count was over 200 cells/µL. METHODS: Standardized data collection at seven tertiary-referral inflammatory eye disease clinics. MAIN OUTCOME MEASURES: Standardization of Uveitis Nomenclature anatomic classification and descriptors, cause of uveitis, and visual acuity RESULTS: Peripheral CD4+ T cell counts varied between 207 and 1777 (median = 421) cells/µL at the time of diagnosis of uveitis. Uveitis was classified anatomically as anterior (47.5%), intermediate (6.6%), anterior/intermediate (16.4%), posterior (14.8%) and pan (14.8%). Specific causes of uveitis included infections (34.4%), with syphilis responsible for 16.4% of all cases, and defined immunological disorders (27.0%); no cause for the inflammation was identified in 34.4% of persons. Visual acuity was better than 6/15 in 66.7% and 6/60 or worse in 11.8% of 93 eyes at presentation, and better than 6/15 in 82.4% and 6/60 or worse in 8.8% of 34 eyes at 1 year of follow-up. CONCLUSIONS: Both infectious and non-infectious forms of uveitis occur in individuals who are infected with human immunodeficiency virus and have preserved or restored peripheral CD4+ T cell levels. Individuals who are human immunodeficiency virus-positive and present with uveitis should be evaluated in the same way all patients with uveitis are assessed.
Subject(s)
CD4-Positive T-Lymphocytes/immunology , HIV Infections/complications , Uveitis/complications , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antiviral Agents/therapeutic use , CD4 Lymphocyte Count , Female , Glucocorticoids/therapeutic use , HIV Infections/diagnosis , HIV Infections/immunology , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Time Factors , Uveitis/diagnosis , Uveitis/immunology , Visual Acuity , Young AdultABSTRACT
We report a positive outcome of postcataract endophthalmitis caused by Enterobacter cloacae, which has previously resulted in poor outcomes in endophthalmitis. A 67-year-old man underwent uncomplicated cataract surgery. On the morning of postoperative day (POD) #1, he had significant anterior chamber inflammation without pain, hypopyon, or vitritis but then rapidly developed hypopyon and worsening visual acuity. He underwent a tap and inject with vancomycin and ceftazidime and was prescribed topical steroids and antibiotics as well as oral levofloxacin. On POD #3, cultures of the vitreous and aqueous returned positive for E. cloacae. By POD #6, his hypopyon had resolved with improved vitritis, decreased inflammation, and visual acuity of 20/200. Two weeks after surgery, his best-corrected visual acuity was 20/60. Contrary to prior reports, we demonstrate that it is possible to achieve a good outcome in cases of E. cloacae endophthalmitis treated early with appropriate antibiotics and anti-inflammatory agents.
ABSTRACT
OBJECTIVE: To determine the penetration of 1% voriconazole solution into the aqueous and vitreous following topical administration. METHODS: A prospective nonrandomized study of 13 patients scheduled for pars plana vitrectomy surgery. Aqueous and vitreous samples were obtained and analyzed after topical administration of 1% voriconazole every 2 hours for 24 hours before surgery. Drug concentration quantitation was performed using high-performance liquid chromatography. RESULTS: The mean (SD) sampling time after topical administration of the last voriconazole dose was 24 (14) minutes. The mean (SD) voriconazole concentrations in the aqueous and vitreous were 6.49 (3.04) microg/mL and 0.16 (0.08) microg/mL, respectively. Aqueous concentrations exceeded the minimum inhibitory concentration at which 90% of isolates are inhibited (MIC(90)) for a wide spectrum of fungi and mold, including Aspergillus, Fusarium, and Candida species. Vitreous concentrations of voriconazole exceeded the MIC(90) for Candida albicans. CONCLUSION: Topically administered voriconazole achieves therapeutic concentrations in the aqueous of the noninflamed human eye for many fungi and molds and achieves therapeutic levels in the vitreous for Candida species. Topical voriconazole may be a useful agent for the management of fungal keratitis and for prophylaxis against the development of fungal endophthalmitis.